Interventions & Surgical Procedures for Neck Pain

patient education is if pain is not absolved focus on

function (typically chronic pts)

educate the patient on

prognostic factors, natural hx, nature of neurogenic/pathic pain, activity modification, gradual return to reg. exercise/activity

PT management for pts w/ Acute/High Irritability cervical pain 1st stage

try McKenzie method (centralize)

goals for pts w/ Acute/High Irritability cervical pain

Symptom modulation

Reduce aggravating factors

Maintain function

interventions for cervical pain pts w/ Acute/High Irritability

Education (modify activity)

Repeated mvmt: Centralization? Symptomatic or mechanical changes

Traction (manual or mechanical)

MT therapy for C & T spine (can see centralization)

Neurodynamics exercise: Sliders

Light Scapular thoracic & cervical thoracic exercise

Strength & mobility

if a pt does not have a directional preference or highly irritable, what is a good intervention to try

traction (mechanical or manual)

goals for pts w/ Subacute/Lower Irritability cervical pain

Symptom modulation

Restore previous level of function

interventions for pts w/ Subacute/Lower Irritability cervical pain

Education

MT therapy for cervical & thoracic spine

Neurodynamics exercise: Sliders → Tensioners

Progressive Scapular thoracic & cervical thoracic exercise: Strength & mobility

when to refer cervical pain pts?

Signs of myelopathy (unexplained/no imaging)

Too irritable to tolerate any treatment

Symptoms not resolving ( >4 weeks)

Rapidly worsening neurologic status: Profound motor weakness

medical management for pts w/ cervical pain

Oral corticosteroids (Medrol Dosepak) (acute inflammatory)

Injection (transforaminal CSI)

Surgical Interventions

Epidural/Transforaminal Steroid Injection for Cervical Radiculopathy pts who demonstrate

Progressive motor weakness

Unresponsive to conservative management

Inflammatory in nature

short term benefit for Epidural/Transforaminal Steroid Injection for pts w/ cervical radic

weeks to months, In severe cases is may create a therapeutic window

indications for Anterior Cervical Discectomy & Fusion (ACDF)

Persistent cervical radiculopathy

Cervical myelopathy

stabilize spine after cervical spine trauma

stabilize spine after osteodiscitis

Anterior Cervical Discectomy & Fusion (ACDF) Outcomes are Generally favorable for symptom resolution in chronic CR. A Myopathic-

stops progression of disease, May not see large improvement from preoperative status

Anterior Cervical Discectomy & Fusion (ACDF) complications are

relatively low, more complex procedure higher = complication rate

Anterior Cervical Discectomy & Fusion (ACDF) increases risk of

adjacent degenerative changes, 16%-38% at 10 years. Most are symptomatic & may be subclinical. 22.2% pts need reoperation at adjacent segments by 10 yrs postoperatively

Anterior Cervical Discectomy & Fusion (ACDF) C5 palsy’s are relatively common (LMN) show

weak flexion, abduction, & ER (atrophy of shoulder muscle)

Anterior Cervical Discectomy & Fusion (ACDF) post op management w/ soft/hard collar

Multi level 4-6 weeks, single level 1-2 weeks

Anterior Cervical Discectomy & Fusion (ACDF), Start postoperative rehab

around 4-6 weeks

ACDF phase 1: at 4-8 weeks perform

AROM

Light cervical isometrics

Light scapulothoracic muscle training

ACDF phase 2 2-8 weeks to 6 months

AROM

Progressive cervical strengthening

Progressive Scapulothoracic strengthening

ACDF Post Operative Management post op protocols may

vary by surgeon and procedure, contact physician if patient does not have a protocol!

disc replacement indications

1-2 level cervical disc disease

Radiculopathy

Myelopathy

No instability: >3.5 mm of translation during Flexion/extension radiographs

Usually younger

disc replacement contraindications

Metabolic bone disease

Malignancy

Inflammatory spondyloarthropathy

disc replacement precautions

Prior surgery at the level

Advance DJD/DDD of the area

Disc Replacement procedure

Access anterior cervical spine

Discectomy

Removal of PLL

Implantation of disc replacement

Disc Replacement outcomes

Similar to Superior to ACDF in medium & short term

Less adjacent degeneration

Return to work 40 days for DR vs 60 days w/ fusion

Post operative protocols for collaring for disc replacement

soft collar for 1-2 wks

Post operative protocols for disc replacement rehab starts at

2 weeks

Post operative protocols for disc replacement, 4 weeks post op begin

ight strengthening of the scapulothoracic

Isometrics of cervical spine muscles

No heavy lifting - >25 lbs

Post operative protocols for disc replacement, 6 weeks post op begin

Progressive strengthening of cervical thoracic muscles: Integrate UE

Functional/Work training

No precautions